Abstract
Purpose
To evaluate the impact of trabecular micro bypass stents (iStent Inject) on refractive outcomes with toric intraocular lens (IOL) in glaucomatous eyes.
Methods
We identified glaucomatous eyes receiving a toric IOL between October 2017 and December 2020. Eyes with iStent implantation were included in the study group and eyes undergoing isolated phacoemulsification served as controls. Corrected and uncorrected visual acuity, manifest refraction, intraocular pressure (IOP), and number of hypotensive drugs three months after surgery were evaluated.
Results
26 eyes comprised the study group and 41 eyes the control group. Mean postoperative refractive cylinder was 0.26D in the control and 0.11D in the iStent group, with 63% and 85% of eyes with a cylinder of 0 and 85% and 92% of eyes with a cylinder ≤ 0.5D respectively. The mean absolute difference between target and outcome spherical equivalent was 0.26D in the control and 0.22D in the iStent group, with all eyes within 0.75D of target. LogMar uncorrected postoperative vision in eyes targeted for emmetropia was 0.04 in the control and 0.03 in the iStent group. There was a statistically significant reduction in IOP and number of hypotensive drugs in both groups, with a mean decrease in IOP of 8.6% in the control and 15.7% in the iStent group. The number of hypotensive drugs dropped from 1.63 ± 0.80 to 1.34 ± 0.91 in the control group and from 2.12 ± 0.65 to 0.44 ± 0.71 in the iStent group.
Conclusion
Toric IOLs provide predictable refractive outcomes in glaucomatous eyes undergoing combined phacoemulsification with iStent implantation, reducing postoperative spectacle dependence.
Similar content being viewed by others
Availability of data and material
All data support their published claims and comply with field standards. Data has been deposited in Synapse.
References
Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY (2014) Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 121:2081–2090
Jonas JB, Aung T, Bourne RR, Bron AM, Ritch R, Panda-Jonas S (2017) Glaucoma lancet 390:2183–2193
Buffet J, Brasnu E, Baudouin C, Labbé A (2017) Efficacy of 2 trabecular micro-bypass stents during phacoemulsification for mild to advanced primary open-angle glaucoma controlled with topical hypotensive medications. J Glaucoma 26:1149–1154
Neuhann TH, Hornbeak DM, Neuhann RT, Giamporcaro JE (2019) Long-term effectiveness and safety of trabecular microbypass stent implantation with cataract surgery in patients with glaucoma or ocular hypertension: five-year outcomes. J Cataract Refract Surg 45:312–320
Ferguson TJ, Swan RJ, Bleeker A, Dockter Z, Karpuk KL, Schweitzer J et al (2020) Trabecular microbypass stent implantation in pseudoexfoliative glaucoma: long-term results. J Cataract Refract Surg 46:1284–1289
Clement C, Howes F, Ioannidis AS, Shiu M, Manning D, Lusthaus J et al (2020) Two-year multicenter outcomes of iStent inject trabecular micro-bypass stents combined with phacoemulsification in various types of glaucoma and ocular hypertension. Clin Ophthalmol 14:3507–3517
Salby AM, Skalicky SE (2020) Combined iStent® inject trabecular micro-bypass and phacoemulsification in Australian patients with open-angle glaucoma. Clin Ophthalmol 14:985–993
Shalaby WS, Jia J, Katz LJ, Lee D (2021) iStent inject: comprehensive review. J Cataract Refract Surg 47(385–399):9
Ioannidis AS, Töteberg-Harms M, Hamann T, Hodge C (2020) Refractive outcomes after trabecular micro-bypass stents (iStent inject) with cataract extraction in open-angle glaucoma. Clin Ophthalmol 14:517–524
Scott RA, Ferguson TJ, Stephens JD, Berdahl JP (2019) Refractive outcomes after trabecular microbypass stent with cataract extraction in open-angle glaucoma. Clin Ophthalmol 13:1331–1340
Astigmatism double angle plot tool | ASCRS (2020) Available from: http://ascrs.org/astigmatism-double-angle-plot-tool. Accessed March 15
Belovay GW, Naqi A, Chan BJ, Rateb M, Ahmed II (2012) Using multiple trabecular micro-bypass stents in cataract patients to treat open-angle glaucoma. J Cataract Refract Surg 38:1911–1917
Brown RH, Zhong L, Bozeman CW, Lynch MG (2015) Toric intraocular lens outcomes in patients with glaucoma. J Refract Surg 31:366–372
Lundström M, Dickman M, Henry Y, Manning S, Rosen P, Tassignon MJ et al (2018) Risk factors for refractive error after cataract surgery: analysis of 282 811 cataract extractions reported to the European registry of quality outcomes for cataract and refractive surgery. J Cataract Refract Surg 44:447–452
Manoharan N, Patnaik JL, Bonnell LN, SooHoo JR, Pantcheva MB, Kahook MY (2018) Refractive outcomes of phacoemulsification cataract surgery in glaucoma patients. J Cataract Refract Surg 44:348–354
Shingleton BJ, Pasternack JJ, Hung JW, O’Donoghue MW (2006) Three and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal. J Glaucoma 15:494–498
Chan HHL, Kong YXG (2017) Glaucoma surgery and induced astigmatism: a systematic review. Eye Vis (Lond) 4:27. https://doi.org/10.1186/s40662-017-0090-x
Funding
No funds, grants, or other support was received.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare they have no financial interests or other conflicts of interest.
Human or Animal rights
This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Ethical approval
The Ethics Committee of the Hospital Clínico San Carlos approved this study and waived the requirement of individual informed consent for participation and publication since all data were deidentified.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
López-Caballero, C., Sánchez-Sánchez, C., Puerto, B. et al. Refractive outcomes of toric intraocular lens in combined trabecular micro bypass stent implantation and cataract surgery in glaucomatous eyes. Int Ophthalmol 42, 2711–2718 (2022). https://doi.org/10.1007/s10792-022-02259-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-022-02259-9